| NPI | 1497193593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN LGSW 25811) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60065645) |
| 101YM0800X Counselor, Mental Health (Licence: WA SC60229390) | |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2017-03-27 |